1356406870 NPI number — MS. MARY HELEN 'NELL' WEGMANN MA, LMFT

Table of content: MS. MARY HELEN 'NELL' WEGMANN MA, LMFT (NPI 1356406870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356406870 NPI number — MS. MARY HELEN 'NELL' WEGMANN MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEGMANN
Provider First Name:
MARY HELEN
Provider Middle Name:
'NELL'
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEGMANN
Provider Other First Name:
NELL
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356406870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 LIBBIE AVE
Provider Second Line Business Mailing Address:
COUPLES COUNSELING LLC
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-2617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-873-0338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 LIBBIE AVE
Provider Second Line Business Practice Location Address:
COUPLES COUNSELING LLC
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-873-0338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  79-124 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 0717001201 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 79-124 . This is a "LMFT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0717001201 . This is a "VIRGINIA LMFT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".